United States

Coverage and out-of-pocket costs

Private insurance plans use formularies — lists of covered medicines organised into cost tiers. Medicare Part D plans and state Medicaid programmes each maintain their own formularies and cost-sharing rules. People without insurance generally pay the pharmacy's cash price, which varies widely between pharmacies. Federal law requires pharmaceutical manufacturers to offer rebates to Medicaid, and the Inflation Reduction Act introduced Medicare negotiation for selected high-cost medicines.

Medicine names and availability

The FDA approves medicines under their generic (USAN) names; brand names differ by manufacturer. A generic equivalent is usually available once patents and exclusivity expire, and pharmacists in most states may substitute an FDA-rated generic unless the prescriber objects.

Questions for your pharmacist or plan

• Is this exact active ingredient, strength and formulation approved and available locally?
• Is my prescription covered, and do any authorisation or eligibility conditions apply?
• Which official programme or plan document explains my current costs?

Authoritative sources

• U.S. Food and Drug Administration (FDA)
• Medicare.gov
• Medicaid.gov
• MedlinePlus